Effects Of The Nurse-led General Practitioners Team Home Visits Program On The Health Status Of The Community-dwelling Oldest Old

ObjectiveTo investigate the health status of the community-dwelling oldest old and the service status of general practitioners team(GP Team) in Shanghai; to explore the effects of the nurse-led GP Team home visits program on the health status of the community-dwelling oldest old.MethodsThis study includes two stages.The first stage: A cross-sectional study was carried out in this stage, including a survey about the health status of the community-dwelling oldest old and a survey about the service status of GP Team in Shanghai.(1)The health status of the community-dwelling oldest old:390participants aged80and over living in3communities in Shanghai were enrolled by the non-probability sampling. The participants were interviewed by questionnaires including short portable mental status questionnaire (SPMSQ), social demographic questionnaire, activities of daily living scale(ADL), Geriatric Depression Scale(GDS-15), University of California Los Angeles Loneliness Scale(UCLA-20) and World Health Organization Quality of Life BREF scale(WHOQOL-BREF). The data was analyzed by SPSS17.0.(2)The service status of GP Team survey was conducted in11communities in Shanghai,52GP Teams were enrolled by non-probability sampling, and required the team members filled out "The service status of GP Team provide for community-dwelling oldest old" questionnaire. Furthermore,9GP Team members were invited to take part in the personal in-depth interview about "the services GP Team provided for oldest old","nurse’s role in the GP Team" and "the available of the nurse-led GP Team home visits program", etc. The data was analyzed by SPSS17.0and category analysis method.The second stage:A quasi-experimental study design was conducted in this stage.140aged80and over and cognitively intact people were divided into the intervention group (n=72) and the control group (n=68). The intervention group received the GP Team home visits program for12months. The control group received routine community health service for12months. The ADLs, GDS-15, UCLA-20and QOL scores change were compared by the repeated-measure ANOVA and multivariate ANOVA.Results1.The health status of the community-dwelling oldest old:①The chronic disease prevalence rate of the Shanghai community-dwelling oldest old was93.6%;66.2%of the participants had ADL functional impairments to some extent;②The score of GDS-15was6.44±2.78(range from0to15), the depression prevalence was63.3%; the score of UCLA-20was46.32±6.41(range from29to67), the loneliness prevalence was81.3%;③The QOL total score and the physical domain, psychological domain, social domain, environment domain scores were46.55±5.09,11.14±1.76,11.70±1.65,12.94±1.58and10.77±1.78respectively. All of the scores were significantly lower than the international norms’(P<0.001).④Linear multivariate regression analysis indicated that ADL, depression, loneliness, number of chronic diseases, number of children, educational level, economic level, living status, religion, age and gender were the main factors affected the aged people’s quality of life.2.The service status of community general practitioners team:①The average age of the team nurses was38.58±7.66(range from24to59), the average nursing work years was18.01±7.88(range from3to35);86.6%of the team nurses had the professional title of senior nurse or supervisor nurse.②the most frequent services GP Team provided for the oldest old were blood pressure monitoring, intramuscular injection, intravenous infusion and blood sugar monitoring. Services such as psychological nursing, disease guidance, nurse helps taking medicine and sending medicine to the patients’ home were less developed.③The GP Team’s work were emphasized on treatment of diseases, the preventive care was looked over, time assigned to home visits was little. The team nurses’ role and function was not full played.3.The results of repeated measures ANOVA showed that the scores of ADLs existed no group effect and interaction effect (P>0.05). As is indicated by multivariate ANOVA, the scores of ADLs between the intervention group and the control group had no statistic difference at the beginning of the intervention and3months,6months,12months later (P>0.05).4.The results of repeated measures ANOVA showed that the scores of GDS-15existed the interaction effect between time factor and group factor (P<0.001). As is indicated by multivariate ANOVA, the scores of GDS-15were significantly different between the intervention group and the control group at the3months,6months,12months after intervention(P<0.001), yet no statistic difference was found at the beginning of intervention (P>0.05).5.The results of repeated measures ANOVA showed that the scores of UCLA-20existed the interaction effect between time factor and group factor (P<0.001). As is indicated by multivariate ANOVA, the scores of UCLA-20were significantly different between the intervention group and the control group at the3months,6months,12months after intervention(P<0.001), yet no statistic difference was found at the beginning of intervention (P>0.05).6.The results of repeated measures ANOVA showed that the QOL total score and the physical domain, psychological domain, social domain, environment domain scores existed the interaction effect between time factor and group factor (P<0.001). As is indicated by multivariate ANOVA, the QOL total score and four domains scores were significantly different between the intervention group and the control group at the3months,6months,12months after intervention(P<0.001), yet no statistic difference was found at the beginning of intervention (P>0.05).Conclusion1.The ADL among the community-dwelling oldest old were poor. People aged80and over had high prevalence of depression and loneliness. Their quality of life were poor.2.The general practitioners team’s work were emphasized on treatment of diseases, the preventive care was looked over. The services now provided for the elderly could not satisfied for the health requests of the community-dwelling oldest old.3.The nurse-led general practitioners team home visits program could significantly improve the health status among community-dwelling oldest old.